Provider Demographics
NPI:1164009478
Name:GEORGE, GLADYS (PHARMD)
Entity Type:Individual
Prefix:
First Name:GLADYS
Middle Name:
Last Name:GEORGE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:791 HAMBURG TPKE
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-8416
Mailing Address - Country:US
Mailing Address - Phone:973-832-7200
Mailing Address - Fax:
Practice Address - Street 1:791 HAMBURG TPKE
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-8416
Practice Address - Country:US
Practice Address - Phone:973-832-7200
Practice Address - Fax:973-832-7201
Is Sole Proprietor?:No
Enumeration Date:2021-03-24
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03768500183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist